HomeMy WebLinkAbout08-20-13 � J 1505610105
REV-1500�'�=,°>�F'>,�.�
PA Depaltment of Revenue Pe�nsylvania OFFICIAL uSE ONLY
Bureau of 7ndividual Taxes �"",„`", " County Code Year File Number
aoaoxz8o6oi � INHERITANCE TAX RETURN �� (2 O�n c
Harrisburg PA S7i28-o6oi RESIDENT DECEDENT ,:J N J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Dealh MMDDYYYY Date of 8irth MMD�YYYY
01/16/2013 06(27/1919
DecedenPs Last Name Suffx Decedent's First Name MI
CONTROY MARY ' E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffx Spouse's First Name MI
Spouse's Social Security Number - ��
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FIL4 IN APPROPRIATE OVALS BELOW
� 1.Origina�Raturn p 2. Supplemental Return O 3. Remaindei Return(Dale of Death
Priorto 72-13-82)
O 4. Limited Estate O 4a. Puture Interesl Compromise(date of O 5. Fetlerel Estate Tax ReWrn Required
death after 72-12-62)
� 6. Decedent�ied Testate O 7. Decedent Maintained a Living Trust 0 8, Total Number of Safe Deposit Boxes
(Attach Copy of Wilq (Attach Copy of 7rust.)
O 9. Li�igation Proceeds Receivetl O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sea 9113(A)
Between 1231-91 and 1-1-95) (AHach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TA%INFORMATION SHOULD BE OIRECTED T0:
Name Daytime Telephone Number
JANET A HOLM (540) 273-8857
C6ISTER OF WII��USE�SNL�YrZ
� O _� G� Q
c '
First Line of Address _ p 'b n c�� .+ a
580 LAKE CAROLINE DRIVE 'D x' r ^� zr'
.rp, _= ' � ° .. �
Second Line ofAddress -_ � j: �� '
� - �J �n "L' -" ��
c.� �
C7 <7 .
City or PoSt Offce S[ate ZIP Code � --i DATE FI�-ED �j
RUTHER GLEN VA 22546 �y�,. t ' �'� '"s -n
�
Correspondent's e-mail address:
Untler penalties of perjury,I tleclare ihat I hava examined this renrn,induding accompanying schetlules and statements,antl to ihe best of my knowletlge antl beiief,
it is true,correct and complete.Declaration of preparer other than the personal representative is basetl on all information of which preparer has any knowletlge.
SIGN�F PERSON RE�SPONSIBIE FJJR F G RETURN DATE
�� �— ��/
ADOR�p
580 LAKE CAROLINE DRIVE, RUTHER GLEN, VA 22546
SIGN R F PREPAF3�R OTH THAN EPRESENTA VE DATE��3/
� (J
ADDRESS
5128 ERBS BRIDGE ROAD, MECHANICSBURG, PA 17050
PLEASE USE ORIGINAL FORM ONLV
Side 1
� 1505610105 1505610105 �
��
J 1505610205
REV-150D EX(FI)
DecedenPS Social Security Number
.... - __.._._ ___... __.__. __..._... ,.,,
oecedenrs Name: MARY E CONTROY �
RECAPITULATION
1. fteal Estate(SChedule A) . ... . . . ... ! ��
t. ; 157,452.11 !
2. Stocks and Bonds(SChedule B) . . . ... .. ... . .... . .. . ... .... . .. . ... . .. .. 2. r� -�m'
�.._�_.._.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ... . . 3. � �
�__'_..--�.._...�..___�'.�..._' .
4. Mortgages and Notes Receivable(SChedule D) q, ' ��
. .... . .. . ... ... . . . . . ... ... . !
�.._. _._�_.�._..�-'_..�_.,_..�...___..�._
I
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . .. .. 5. '• $,885.12 .
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... ... 6. � � � V `^'
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property � ���� -'� --�- �--�-��--�� -��-�
(SChedule G) O Separate Billing Requesled.. . .... . Z � � '
�..__...._.._.,_�._.._. .�_...m,_...�
8. Total Gross Assets(total Lines i through 7).. . .... . ... ... ... . .... .... ... 8. i 166,337.23
9. Funeral Expenses and Administrative Costs(Schedule H).. ... . ... . ... . .. . .. 9.i 13,766.42 '��
���
70. Debts of Decedent,Mortgage Liabilities and Lie�s(Schedule I).. . ... ..... .. . . 10. �, � 15,936.61 !
it. Total Deductions(total Lines 9 and 10�. ........ ... . . ... ... ... . .... ..... 1L ��` 29,703.03 ;
t__.'._..._....._.,._.._.._w.__,.�_ .___..._...._
12. Net Value of Estate(Line 8 minus Line 11) ... ..... .. �
�z. 4 136,63420
13. Chantable and Govemmental Bequests/Sec 9173 Tmsts for which -----�-�+
_-..�_.__...�
an election to tax has not been made(Schedule J) . ... . ... ... . .. . ... . ... . . 13.f '.
___
14. Net Value Subject to Tax(Line 12 minus Line 13) .. ... . ... . . � � � v '
�a. 136,634.20
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at Ihe spousal tax rate,or
transfers under Sec.9116 ... -. . -_....,. .-- . __._ .. ....... .� : .._ . _._. ..... ____.. _ __ _ _
(a)(1.2)X.0_ I 15.;_--
76. AmountofLinel4taxable '�....�^`"--"""."-'_"�-"-�t � --'-" -----._�.___.�r
atlinea�rete X.045 6,148.54 + �g. � 6,148.54 �
17. Amount of Line 14 taxabte . "-"'-�'1 -'-���--------------
atsiblingrete X.12 �� i �� ,'
i
18. Amount of Line 14 tezable �� �� '---`�'""'""- -
,i._.___'"` .�_.� 18. ; �
19. TAX IDUEaI rate X.15... ...1.... . .. . . . .... . ..... .. . . ... . ... . .j.... 19.' ..�___-�..___..._..__.6'�
20. FItL IP!THE OVAL 1F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610205 1505610205 �
REV-1500 EX(FI) Page 3 F1Ie Number
� OecedenYs Complete Address:
OECEDENT'S NAME
MARY E CON7ROY
STREETADORESS
208 WEST MAPLE AVE
CITY ; STATE � ZIP
CAMP HILI, PA I 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (t) 6,148.54
2. CreditslPayments
A.Pnor Payments _.
8.Discaunt
tolal Credits(A+B) (2)
3. Interest
(3j
4. Ii Une 2 is greater than Line 1+Line 3,enter lhe diBerence. This is lhe OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4j
5. If Une 1 �Line 3 is greater than Line 2,enter the diBerence.This is lhe TAX DUE. (5) 6,146.54
Make check payable to: REGISTER OF W1LLS,AGENT.
—_______.----- ---- - --- --— -- -------- ---- ____
� —— -- — -- - — -- _ - — — — — - - - -- -- —
PLEASE ANSWER THE fOLLOWING QUESTIONS BY PIACING AN "X" IN THE APPROPRIATE BLOCKS
t. Did decedent make a transfer and: Yes No
a. retain the use or income oi the property transferred.......................................................................................... ❑ �
b. 2tain the rigM to designate who shall use the property transfeved or its income ......................................_.... ❑ �
c. retain a reversionary interest .............................................................................................................................. ❑ �
d. receive the promise for lite of either payments,benefits w care?...................................................................... ❑ �
2. If death uccurced afler Dec.12,1982,did decedeM uar�sier propeAy within one year oi deaih
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent ovm an"in trust(or"or payable-upon-deafh bank accaunt or security at his or her death?.............. ❑ �
4. Did decedent ovm an individual retlrement account,annuity or other non-probate pmperty,which
oontains a bene6dary designation? ........................................................................................................................ ❑ �
If THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND fILE IT AS PART OF THE RE7URN.
_ , , ..�— ---------- ----- ---�---- — .� � �
L^— — - — � _. _ — - - - - - - - - -- -- � �
For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or afler Jan. 1, 1995, !he tax rate imposed on the net value oi Uansfers to or tor the use of lhe surviving spouse is 0 percent
�72 P.S.§9116(a)(1.1)(ii)].The statule does not exempt a transfer to a surviving spouse trom tax,and the slatutory requiremenis fa disclosure of assels and
filing a tax relum are still applicable even if the surviving spouse is lhe only beneficiary.
For dates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers from a deceased child 21 years o�age or younger at dealh to or for the use af a natural parent,a�
adoptive parenl or a slepparent of lhe child is 0 percent(72 P.S.§9116(a)(1,2)�.
• The tax rale imposed on the nel value ot Iransfers to a far the use of the decedeni's Iineal benefiqaries is 4.5 percent,ezcept as noted in�72 P.S.§9116(a)(1)].
. The lax rate imposed on the net value of hansfers ro or tor the use of Ihe decedenfs siblings is 12 percent�72 P.S.§9116(a)(t.3)].A sibling is deEned,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether 6y blood or adoption.
REV-1502 EX+(12-12)
� �pennsylvania SCHEDULE A
DEPARTMENT�F REVENUE
INHERITAN�TAXRENRN REAL ESTATE
RESIDEM DECEDEM
ESTATE OF: FILE NUMBER;
MARY E CONTROY 21 13 0095
All real Qroperty owned solefy or as a tenaM in common must be reported at fatr market value.Fair market value is defined as the price at�vhich property
would be exchanged behveen a willing buyer and a willing seller,nelther being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that Is jointly-owned with right of survivonhi0 mvst be disclosed on Schedu�e F.
Attach a copy of the settlement sheet if the property has been so�d.
ITEM Include a copy of the deed showing deadenPS interest if owned as tenant in common. VALUE AT DATE
NUMBER
DESCRIPTION Of DEATH
1� 208 W MAPLE AVE.,CAMP HILI,PA 17Q11 (SETTLEMENT SHEET ATTACHED) 157,452.11
TOTAL(Also enter on Line 1, Rewpitulation.) $ 157,452.11
if more space is needed,use additional sheets of paper of the same size.
REV-�SaB E%r(o&�z)
� �j,.�]pennsylvania SCNEDULE E
+��� UEPPRTMENTOFREVENUE CASM, BANK DEPOSITS & MISC.
,r,�newrnrucErnzae�rsn PERSONAL PROPERTY
RESIOEM DECEOEM
ESTATE OF: FIIE NUMBER:
MARY E CONTROY 21 13 0095
Indude the praeeds ot li[igation and the date the proceeds were recefved by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
�M VALUE AT DATE
NUMBER DESCRIPTION OF DEAiH
1. AlC NUMBER 571121144 SOVEREIGN BANK�CHECKING,P 0 80X 84005,BOSTON MA 02284 4,637.41
2 AIC NUMBER 2334016496 SOVEREIGN BANK-SAVINGS,P 0 BOX 84005,BOSTON MA 02284 1,040.20
3 A/C NUMBER 0538126509 METRO BANK-CHECKING,3801 PAXTON ST.,HARRISBURG,PA 17111 1,707.51
q PERSONALPROPERTY
1,500.00
TOTAL (Also en[er on Une 5, Recapitulacion) $ 8.885.�2
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
���pennsytvania SCHEDULE H
• Y J
' oecnarnenroFaevervue FUNERAL EXPENSES AND
mnea�raNCeraxaETUan ADMINISTRATIVE COSTS
RESIDENT DECEDEN7
ESTATE OF FILE NUMBER
MAFtY E CONTROY 21 13 0095
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1' FUNERAL HOME 9,19022
2 GRAVE DIGGING 1,060.00
3 HEAD STONE 1,970.00
a LUNCHEON AND HOTEL 852.70
e. ADMINISTRAT[VE C�STS:
I. Personal Representative Commissions:
Name(s)of Personal kepresentative(s)____.__ ____________.________
SGeet Address
Cdy -�---�- --�- ----......_- __-----------�--....__State_. . ___ZIP _. ._--- - -....--
Year(s)Commission Paid:
2. Attomey Fees:
95.00
3. Family Exemption: Qf decetlent's address is not the same as daimant's, attach explanation.)
Claimant
Street Address
City _ .__._... _ _. .___._. ___._ -State ....._._ZIP .._._ _ — .
Relatlonshlp of Claimant to Decedent
4� Probate Fees�. 348.50
5. Acrountant Fees:
6. Tax Retum Preparer Fees: 250.00
7.
TO7Al(Also enter on Line 9, Recapitulation) $ 13,766.42
If more space is neetled, use atlditional shee[s of paper of the same size.
REV-1512 E%+(12-12)
' 3[i]pennsylvania SCHEDULE I
��� DEPARTMEMOFqEVENUE DEBTS OF DECEDENT,
[NHER(rANCETAXRENPN MORTGAGE LIABILITIES & LIENS
RE51D£NT DECEDEM
ES7ATE OF FILE NUMBER
MARY E CONTROY 21 13 0095
Report debts Incurred by the decedent prfor to death that remained unpaid at the date ot death,including unre(mbursed mediwl expenses.
iTEM VALUE AT DATE
NUM6ER DESCRIPTION OF�EA7H
1� MEDICAL INSURANCE 511.38
2 COMCAST 390.09
3 DIAMOND PHARMACY 328.59
4 DONATION 130.00
5 GRISWALD 120.00
6 CLEANING 200.00
7 LINCOLN NATIONAL 30.91
8 MACY'S 106.72
9 MISCELLANEOUS 351.12
10 NATIONWIDE HOME 392.50
11 PA AMERICAN WATER CO 150.90
12 POSTAGE 20.40
13 PP&L 216.02
14 SAC OIL 1,396.00
15 SEWER 136.50
16 LAWN CARE 475.00
17 REPAfRS 10,'160.00
18 JASON MILLER,ADDITIONAL SELLER ASSIST SALE OF MAPLE STREET 818.48
70iAL(Also enter on Line 10, Rewpitulation) ; 15,936.61
If more space is needed,Insert additional sheets of the same size.
REV-t513 E%+(01-10)
' (�1i pennsylvania SCHEDULE J
�s�� OEPAqTMENTOFPFVENUE BENEFICIARIES
INHEARANCE TA%RENtiN
RES\DEM bECEDEM
ESTATE OF: FILE NUMBER:
MARY E CONTROY 21 13 0095
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECENING PROPERtt Do Not List Trustee(s) OF ESTATE
I TAXABLE DiSTR{8U170N5(indude outdght spousal disMbutions and[2nsters under
Sec.9 t 16(a)(1.2).J
1. JANET A HOLM,580 LAKE CAROLINE DR,RUTHER GLEN,VA 22546 DAUGHTER 1!3
2 DONALD J CONTROY,2 FAIRWAY DR,WARMINSTER,PA 18974 SON 1/3
3 RICHARD P CONTROY, 1564 CHATUGE CIR,HIAWASSEE,GA 30546 SON 1/3
ENTER DOLLAR AMOUNTS FOR DISTR[BUTfONS SHOWN ABOVE ON UNES 15 THROUGH YB Of REV-1500 COVER SHEEi,AS APPROPRIA7E.
Il NON-TAXABLE DISTRIBUT[ONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHiCH AN ELECiION TO TAX I$NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMEMAL DISTRIBUTIONS:
1.
TOTAL OF VART II—ENTER 70TAL NON-TAXABLE DISTRIBUTIONS ON L1NE 13 OF REV�I500 COVER SHEEL $
[(more space is needed,use additional sheets of pa0er of the same size.
Oi!71!2011 2:14 PM F9S 9Q�443a12A C3ROLInE LIBR9R1 I� OUO2i0U04
LAST WILL AND TESTAMENT
o�
MARY E. CON2'ROY
I, MARY E. CONTROY, of the Borough ot Shiremanstown,
Cumberland County, Pennsylvania, make, publish and declare this
as and for my Last Will and Testament, hereby revokinq a21 other
Wills and codicils heretofere made by me.
FTRST: I devise .and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which Z hold power of appointment and
together with any insurance policies thereon, ir� equal shares, to
my children, RICHARD P. CONTROY, DONALp J. CONTROY and ,TANET A.
AOI,M, provided that should any of my children predecease me, I
�
give and bequeath such child's share unto his or her issue per
� stirpes by representation, and if there be a failure of same,
� then T give and bequeath such deceased child 's share to my
r.
� surviving children as provided herain. ,
i;, SECONn: In addition to all powers granted to them by
�,:1 law and l�y other provisions oP this Will, T give the fiduciaries
� acting hereunder the following powers, applicable to all proper-
-y ty, exercisable without court approval and effective until actual
'�- distribution of all property:
�\';• (A) To se11 8t public oY private sale, or to lease,
`^�l for any periad of time, any real or personal property and to qive
options for sales, exchanges or leases, for such prices and upon
_� ' such terms (including credit, with or without security) or
�". conditions as are deemed proper. Triis includes the power to give
��,._
� legally sufficient instruments for tzansfer of the property and
to receive the proceeds of any disposition of it.
{B) . To paYtition, subdivide, or improve real estate
and to enter in�.o agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or e�ctinguish restrictions on real estate.
(C) To compromise any claim or controversy and t0
Oii71!2li17 2:14 PDI F9S 81�4=143a129 CAROLINE LIBR9RF IQ OOOa!0009 �
abandon any property which is o£ little or no vaZue,
(D) To invest in all forms of property, including
stocks, common trust funds and mortqage investment funds, without
restriction �o ihvestments authorized for Pennsylvania Piduci-
aries, as are deemed proper, without regard to any principle of
diversiPication, risk or pxoductivity.
(E) To exercise any option, right or pxivilege granted
in insurance policies or in other investments.
(F) To exercise any election ar privileqe given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, giEt and estate or inheritance tax
laws.
, (G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To Horrow money from themselves ox others in order
-�__ to pay debts, taxes, or estate or trust administration e�tpenses,
� �--
` to protect or improve any property hald under my will, and for
investment purposes.
- (I) To sel�ct a mode of payment under any qualified
' retirement plan (pension plan, profit sharing p1an, employee
"�; ,� stock ownership plan, or any other type of qualified plan) to the
`" extent the plan or the law permits them to do so, and to exercise
any other rights whzch they may have under the plan, in whatever
:''.
manner they consider advisable.
- - - TA=Ra: I direct that a11 inheritance, estate,
��..
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
O� IIRTH: All interests hexeunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hareunder, even though vested oz� distribut-
able, shall not be subjec�. to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
2
iii%31/�017 2:14 Pn1 F.9S 8044433124 �:9R�)LINE LIBR9RY � f� OOU4!pOp4
benefiCiary, and furthezmore, shall z�ot be subject to pledge,
assignment, conveyance or anticipa�Cion.
F FTHS T nominate and appoint my children, RICHARD P.
CONTROY, D�NALD S. CONTROY and JANET A. HOLM, Co-�Executors of
this, my Last Will and Testament. I direct tha�. my ExeGUtor or
Executrix, as the case may be, and their successors, shall not be
required to post secu�ity or a bond fpr the performance ot their
duties in any juzisdiction. '
I�i WITNESS WHEREOF, 2 have hereunto set my hand and
seal to this, my Last Wi11 and Testament, this j��. J� day of
I{ _.��1Ni� ,v /
1999 .
I- a :: %%; �.-----
1. y � l
'i' '.� a-..i: C�, �.,_f,,s.�2?-e� (SEAL)
.. _ .� _
MARY E:.' CONTROY /�
_ �,
Signed, sealed, pubJ.isried and declazed by the above-
named Testatrix as and £or her Last Will and Testament in our
presence, who, at her xequest, in her presence and in the
presence of each ocrier, have heraunta subscribed our names as
attesting witnesses.
`�` 1 %j'' d+
Address
� .�^ 1 � :�
, , �..
l � �i . � �;.� /�l�.i.
Addre5s " � '�;r—r--
3
i� ,��� OMB Approval No. 25 2- 65 �
;�'��������: � A. Settlement Statement (HUD-1 )
�II��II�:•i
'��.,
.- , ..
1.Q FHA 2.Q RHS 3.❑ Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
13145 4600035705 446-1796022-703
4.Q VA 5.Q Conv. Ins.
C.Note:This torm is fumished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown.Items marked
"(p.o.c)"were paid outside the closing;they are shown here forinformational purposes and are notincluded in the totals.
D. Name&Address of Borrower: E. Name&Address of Seller: F. Name&Address of Lender:
Jason Miller Estate of Mary E.Coniroy American Neighborhood Mortgage Acceptance
4136 Kittatinny Drive,Mechanicsburg,PA 17050 208 West Maple Avenue,Shiremanstown,PA 17011 700 East Gate Drive,Suite 400,ML Laurel,
New Jersey 08054
G. Property Location: H. Settlement Agent: I. Settlement Date:06/28/2013
208 West Maple Avenue Keystone Land Transfer,L�tl Disbursement Date: 06/28/2013
Camp Hill, PA 17011 3421 Market Sireet,Camp Hill,PA 17011
Shiremanstown Borough
Telephone:717-731-4200 Fax:717-731-1799
Place of Settlement: TitleExpress
3421 Market Street,Camp Hill,PA 17011 Printed 06/28/2013 at 12:01 pm
by KS
. .
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller
707. Contract sales price 179,900.00 401. Contract sales price 179,900.00 �
102. Personal ro erl 402. Personal ro ert
103. Setliement charges ro borwwer(line 1400) 11,39626 403.
104. 404.
105. 405.
Ad'ustments for items aid b selle�in advance Ad'ustments for items aid b seller in advance
106. Cityltown taxes �0 406. Cityltown taxes to
1D7. Counry taxes 06128I2013 to 1213112013 443.17 407. County taxes 0 612 812 01 3 to 12/31I2013 443.17 �
108. School Tax 06128I2013 to 0613012013 19.00 408. School Tax 06/2 812 01 3 to 06/3012013 19.00 '�
109. Sewer 0612812013 ta 0613012013 2.14 409. Sewer 06/2 812 01 3 to 06/3012013 2.14 �
110. 410.
111. - " 411.
N2. 412.
120. Gross Amount Due from Borrower 191,760.57 420. Gross Amount Dueto Seller 180,364.31 I
200. Amounts Paid b or in Behalf of Borrower 500. Reductions In Amount Due to Seller
201. Deposit or earnest money 2,500.00 501. Excess deposit(see inshuctions)
202. Principal amount of new loan(s) 176,641.00 502. Settlement charges to selier pine 1400) 23,132.68 /
203. Existin loa s taken sub'ect b 503. Existin loa s taken sub'ect to
204. 504. Pa off of firs�mor� a e loan
205, 505. Pa off of second mort a e loan
206. SellerAssist 9,161.52 506. SellerAssist 9,181.52 /
207. 507.
208. 506.
209. 509.
Ad'ustments for items unpaid by seller Ad'ustments for items unpaid b seller
210.� Cityltown fazes to 510. City/town taxes to
211. County taxes to 511. County taxes (o
212. School Tax to 512. School Tax to
213. 513.
214. 514.
215. 515.
216. 516.
217. 5??.
218. 518.
219. 519.
2z�. Total Paid b Ifor Borrower 186,322.52 520. Total Reduclion Amount Due Seller 32,314.20
300. Cash at Settlement from/to Borrower 600. Cash at Settlem¢nt tolfrom Seller �
301. Gross amount due irom borrower(line 120) 191,760.57 gp�, Gross amount due to seller(line 420) 180,364.31
302. Less amounis paid bylfor borrower(line 220) 188,322.52 602. Less reductions in amount due seiler(line 520) 32,314.20
303. Cash QX From ❑ To Borrower 3,438.05 603. Cash XQ To ❑ From Selier 146,050.11 /
apo�my ur nur iuv ocono r y n m a inin�espe��sponsenrconcingmmumnb,�^<<eW����b e e isep�iqn�eynoc <yuua�enorciryua� o
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See attached addendum for additional information
Previous editions are obsole.e Page 1 of 4 HUD-1
a •
700. �TotalReatEstateBrokerFees 570,494.00 Paid FrOm Paid From
' Divisionofcommission Iine700 asfollows: BOffoWEr'S Sellef'S
Ot. y5,24Zp0 �p RSRRealrors Funds at Funds at
��Z� $5,247.00 �o RelMax Realty Associates,Inc. Settl2m2nt Settlement
703. Commission paid at settlement �p,qgq� ,�
704. to
800. Items Pa able in Connection with Loan
801. Our ongina�ion charge (Includes Originalion Point 0.000°�or 50.00) 5550.00 ((rom GFE t!1)
802. Your credit or charge(points)forlhe specific inlerest rate chosen $ (trom GFE k2)
803. Your adjusted origination charges (from GFE A) 550.00
804. Appraisal fee to Annie Mac $450.00 P.O.C. B' (from GFE#3)
805. Credif report to UCS (from GFE#3) 44.86
806. Tax service to from GFE#3
807. Flood cedification lo CoreL ic (trom GFE k3) 12.00
808. to
900. Items Re uired b Lender to be Paid in Advance
901. Daily interesl charges from from 06128/201310 07l01/2013 @ 515.7283/day (from GFE tl10) 47.18
902. Mortgage insurance premium for monihs to HUD (from GFE#3) 3,038.05
903. Homeowner's insurance for ears to Alislale Insurance (from GFE#11) 658.56
904. monlhs to from GFE#11
1000. Reserves De osited with Lender
1001. Initial deposit lor your escrow account (from GFE k9) 319.61
7002. Hameowners insurence 3 months b 54.88/month 5164.64
1003. Mortgage insurance months 5 793.52/month S
1004. Property taxes rtronths S 0.00/month S
1005.County tazes 6 months $ 72.091month 5432.54
1006.School Tax 2 months $ 192.64/month 5385.28
1007.Aggrega(e Adjusiment $-662.85
1100. Title Char es
1107. Tille services and lendefs iitle insurance (rom GFE#4 1.622.00
1102. Settlement or dosing lee �p y
1103. Owners tiile insurance-First American Title Insurance Company from GFE#5
1104. Lender's tille insurance-First American Title Insurance Company 51,510.00
1105. Lendefs lille policy limit 5176,641.00 Lender's Policy
1106. Ownefs title policy limit 5779,900.00 Owner's Policy
1107. Agenl's podion of Ihe total title insurence premium 51,232.50
�o Ke sione Land Transfer Ltd
1108. Underwriters portion of ihe total title insurance premium 5292.50
to Firsi American Title Insurance Com an
1109.
1110. Nolary Fee to Kristen D.Shive 15.00 �
7111. Wire Out Fee-Payoff to Ke stone Land Transfer,Lli '�
1112. Tax Cedification Fee to Ke stone Land Transfer,LL 5,pp /
1113. Deed Prep Fee to Ke stone Land Trans(er,Lti 150.00�
1200. Government Recordin and Transfer Char es
1201. Government recording charges $ (from GPE#7) 201.50
�Z�2. Deed$67.00 Mort a e 579.00 Release S �
1203. Transier taxes 3 ((rom GFE k8) 799,00
1204. City/Counly tax/stamps Deed$1,799.00 Mort a e S
1205. StateTaxlstamps Deed$1,799.00 Mort a eS 7,7gg,pp
�Z�� Deed$ Mod a e 5
1207. Record Assignmen�of Mortgage $55.50
1300. AdditionalSeriiementChar es �
1301. Required services thal you can shop lor (from GfE#6) 3 0.
, 1302. to n
1303. Pest InspecfionlHOme Inspecfion fo The Vidus Grouo 5350.00 Q �y
1304. lo
1305. lo
1306. Home Warranty to Firs�American Home Bu ers Protection Co 365.00�
1307. 2073 CountylTownship Tazes lo Jud Prowell ggp.gg�
1308. Inherilance Tax ro Ke stone Land Trans(er,Ltd 9,402.00�
1309. 2013-14 School Taxes to Jud Prowell 2,500.00
1310. Carpenler Bee Treatmen� to Bowers Pest Conirol 238.50
'�� ' � � 11,396.26 23,132.68
`Paid outside of closing by(8)orrower,(Sjeller,(L)ender,(I)nvestor,Bro(K)er."Credit by lender shown on page 1."'Credit by seller shown on page 1.
See attached addendum for additional information
Previous editions are obsolete Page 2 of 4 HUD-1